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Saturday, January 25, 2014

Ontario doesn’t have just one publicly funded school system. We actually afford ourselves the luxury of a public school system and a taxpayer-funded sectarian school system, namely a Catholic school system. The reasons for this are historical, and they are well known. The Confederation pact included a deal that guaranteed the Catholic minority in Ontario a publicly funded school system. It was defended at the time as a means to ensure religious freedom for the Catholic minority in the province.

The reality is that genuine freedom of conscience — as opposed to mere religious freedom — can only be sensibly guaranteed in a society operating a strict separation of state and church(es). The state has no business in funding or subsidizing sectarian educational outlets, hospitals and other institutions. If a religious organization wishes to run its own school or hospital, well, it should put up the cash for it or go away if it is unable to find it. It cannot be that in the 21st century huge amounts of scarce tax monies are provided to religious, ideological educational outfits that preach values that contradict what modern Canada stands for in the world. On anything from reproductive rights to end-of-life issues to marriage equality, the Catholic Church consistently finds itself not only on the wrong side of history, but it also propagates views that the majority of us don’t share. And that is putting it mildly. The very nature of Catholic ideology puts it at loggerheads with anti-discrimination legislation in the province. I am sure you have not forgotten, either, how Catholic school boards across Canada tried to prevent girls in their schools from getting access to the cervical cancer preventing HPV vaccine. The usual Catholic hangups about sex came in the way of protecting girls efficiently from cervical cancer. That kind of nonsense is what our tax monies provide financial backing for in Ontario.

A promotional video produced by Ontario’s Catholic schools has been making the rounds on the Internet during the last few weeks. It features a bunch of students, parents and teachers working in these schools, praising their superior moral education. A lot has rightly been made of the fact that this video implicitly claims to provide a superior education due to the religious values it transmits to its students. Religious organizations, and the Catholic Church is not a unique case here, have always had a keen interest in getting their hands on children. Long-term survival of these ideologies depends on being able to indoctrinate young people at an early age, while they are still impressionable. Despite claims to the contrary by the Ontario Catholic schools that used this video to promote themselves to prospective students and their parents, it is clear that their proposition is that not only are their schools better, but also that their graduates are better human beings courtesy of their ideological religious indoctrination. This is surely offensive to anyone who went to a public school who doesn’t share these particular sectarian values — that would be most of us.

You cannot help but marvel at the guts these marketers of all things Catholic clearly possess. There they are, representatives of an organization whose senior staff spent decades protecting child-molesting pedophiles among its staff across the globe. The German historian Karlheinz Deschner produced a 10-volume opus magnum dedicated to the criminal history of the Roman Catholic Church. Bits and pieces of his detective work are available in English translations, I do recommend them to your attention if you are interested in this issue at all. Even if only half of the horrors he documents in those volumes are true reflections of what actually happened, there can be no doubt at all that the Catholic Church and its representatives should really spend more time reflecting on their own organizational misconduct than on telling us how we ought to live our lives. We certainly should not deliver our children into their schools, and we certainly should not provide tax monies to them in order to ensure the indoctrination of future generations of children with this particular ideology.

The United Nations Human Rights Commission (www.cbc.ca/ontariovotes2007/features/features-faith.html) reportedly agreed in 1999 that Ontario’s exclusive funding for Catholic schools and no funding for other religious organizations’ educational outfits discriminates unfairly against non-Catholics. That said, the situation is worse than it looks. Catholic schools actively discriminate against non-Catholic teachers for employment purposes — using our tax monies to do so — while Catholic teachers are, of course, welcome in our public system. The result is a significant overrepresentation of Catholic educators in the school system.

Sectarian schools are divisive. The video I mentioned earlier features a number of students clearly feeling superior over their public school counterparts, because of the Catholic values that they have internalized courtesy of years of indoctrination. What they ought to have learned is that there is a variety of competing religious ideologies, what these ideologies preach, what their histories are, and so on and so forth. What they shouldn’t have been taught year after year after year is that a particular ideology is true. Cohesive societies are impossible to build under such circumstances. It is obviously unjust to financially privilege Catholic schools only. Seemingly, the Roman Catholic Church sees nothing quite wrong with being in such a privileged situation. It’s this understanding of morality, of course, that has given this particular church such a bad reputation in most developed nations. And don’t take my word for it, the last leader of the church, Pope Benedict (www.dailymail.co.uk/news/article-2041638/Pope-admits-questionable-reputation-Catholic-church-final-day-Germany.html) conceded that the church these days has a “questionable reputation.”

Konrad Yakabuski, in a www.theglobeandmail.com/globe-debate/chapter-and-verse-catholic-school-fundings-unfair/article16462714/ commentary penned for Toronto’s Globe and Mail newspaper, argued this week that public funding for Catholic schools in Ontario ought to end. We should have a debate in Ontario about a school system that we clearly cannot afford any longer and that surely is not fit for purpose. We face declining enrolments, a result of our changing demographics, yet we continue to run a school system that was conceived in very different times indeed. It is time to end public funding for Catholic schools. The majority of Ontarians agree. Consistently, opinion polls indicate that the majority of us want to see public funding for Catholic schools gone sooner rather than later.

Udo Schuklenk is a philosophy professor at Queen’s University, his most recent book is “50 Great Myths About Atheism” (co-authored with Russell Blackford, Wiley-Blackwell 2013). He tweets @schuklenk.

Thursday, January 23, 2014

One of the reasons for Stephen Harper’s past electoral successes had undoubtedly to do with his promise not to touch the abortion or the marriage equality issues while in office. Canadians are not keen on reopening, in particular, the divisive abortion controversy. Realizing that any other course of action would be politically suicidal, Harper has slapped down backbenchers of his own caucus who tried to do otherwise. One has to give credit to the man where credit is due, whether because of political expediency or because he takes promises seriously, the prime minister stuck to his guns on the abortion issue.

Let me say at the outset that I support the status quo on abortion in the country. It’s up to pregnant women to decide whether they have an abortion or whether they carry a pregnancy to term. There are good moral reasons to do with what I take to be the moral status of embryos and fetuses and what I take to be the moral foundations of what is a woman’s absolute right to control what is happening to her body. This is well-trodded ground, though. These arguments have been going back and forth between pro-choicers and anti-choicers at least since the late 1960s. I am not going to bore you with a rehash of these arguments. Those who disagree will continue to disagree. If you believe that an embryo is a person from the moment of conception, nothing that I can say with regard to the science and morals of what dispositional capacities should be required to call something a person will likely sway you toward my take on the issue.

I am more concerned about patterns of what I take to be strategically motivated campaigning by anti-choice groups. I first noticed it in the context of the euthanasia debates. Anti-choice activists, typically closely aligned with conservative religious organizations such as the Roman Catholic Church, have started repackaging their campaign messaging. In the good old days, they’d have simply told us that their God doesn’t like euthanasia and then they would have expected the rest of us to fall in line. That, of course, doesn’t quite cut it any longer today. So they have started resorting to quite vacuous rhetoric such as that euthanasia violates “human dignity.” When you ask what exactly they’re talking about here, Christian ideology comes to the fore in no time. It’s really just an attempt to sell religious views in secular verbiage. Or they claim that “vulnerable” people would be at gravest risk of abuse. A closer look at the social class makeup and educational background of the vast majority who ask for assistance in dying shows that there’s nothing to this scare campaign, either. Call me a cynic, but I am not just a little bit suspicious that this rhetoric is truly mere expediency. It has probably been road tested with pilot groups and has yielded results considered desirable by these same religious campaign organizations.

I cannot help but wonder whether a similar switch has also occurred in the abortion wars. Knowing that the overwhelming majority of Canadians are perfectly comfortable with where we are at with regard to the legal status of abortion, activists have been looking for wedge issues, that is issues where even your average liberal Canadian would scratch their heads wondering whether that might not be problematic. The objective here is to build coalitions with people who would generally consider themselves pro-choice or “on the fence.” What’s needed, much like in the euthanasia debate, are sensitive issues that would make people second-guess their stance on abortion.

And so it goes. The wedge issue chosen — strangely to my mind — isn’t late-term abortion. They typically do not occur for any frivolous or no reason at all, but because of very serious fetal abnormalities that were not caught earlier during pregnancy. While that is so, late-term abortions have been a popular target for anti-choice activism in the United States and elsewhere. Their Canadian brethren have instead zoomed in on sex selection. You know, women having abortions because of the sex of the fetus. I could be mistaken, but it seems it all started with what I still consider a remarkably disingenuous editorial penned by an interim editor of the Canadian Medical Association Journal about two years ago. He suggested that pregnant women should not be provided with information about the sex of their fetus in order to prevent sex-selective abortion among Indo-Canadians. In the editorial, he refers to female fetuses as “girls.” Incredibly, he even referred to “saving” millions of women in India and China, as if the abortion of female fetuses amounted to the murder of either girls or women. It tells you a lot about the Canadian Medical Association Journal that such nonsense should ever have found its way into its editorial pages. There is, in fact, some weak evidence suggesting a slight gender imbalance among newborns of Canadians of East Asian descent, if a report published in the Toronto Star newspaper can be trusted. In the big swing of things, in Canada, this truly is neither here nor there. We must ensure that women are not pressured into having abortions, but ultimately, their motives are irrelevant, for all intent and purposes. We cannot say that women have the right to choose unless we disagree with their motives.

I have had gay friends of mine — happily pro-choice otherwise — who got all agitated when I suggested that at some point down the track, if we had a prenatal test for sexual orientation, some women might choose to abort fetuses testing positive for future homosexuality. They suddenly thought there should be limits on women’s rights to choose. Hello … conservative Christian campaigners, there’s a whole new target group for your material, a new partner in arms so to speak, gays concerned about their future numbers — who would have thought.

Conservative MPs and anti-choice campaigners decided opportunistically to ride this wave, complaining about “female gendercide,” pretending that this is a human rights issue. Of course, this can only be a human rights issue if you already assume that fetuses somehow have sufficient moral standing to grant them human rights. This isn’t actually the case in Canada.

It would be nice if political campaigners were more transparent about their motives. Anti-choice activists have truly refined their campaign techniques with a view to generating empathy among the wider Canadian public. We shouldn’t fall for these tricks.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University, he tweets @schuklenk.

Sunday, January 05, 2014

Tragedy often strikes unexpectedly. Over the last few months a number of cases involving catastrophic brain damage, usually as a result of surgery-gone-wrong, ended up in the news, for all the wrong reasons.

Typically they involve families refusing to accept the professional clinical judgment pertaining to their loved ones. Families insist that their loved ones’ bodies be kept functioning, the hospitals asking for permission to turn off the ventilators and other machines that keep these bodies ticking. More often than not these refusals to accept clinical, professional verdicts are related to strong religious beliefs held by these families. Invariably huge bills are racked up in the ensuing fights between the clinicians, the hospitals employing them and the families and their supporters.

Let me give you two very recent examples of irreversibly brain-damaged patients whose families are fighting tooth and nail to keep their bodies ticking. One case is Canadian, the other occurred in December in the United States. Both cases are ongoing as I write this. The Canadian case involves a patient in irreversibly minimally conscious state, the United States case involves a patient who is plain brain-dead. The former patient has no chance to recover from his injuries, the latter patient – by today’s medical standards – isn’t even a patient any longer, she is actually considered deceased.

The Canadian case

You might have heard about it. The Rasouli case, as it is called in legalese, has already led to a path-breaking court finding in the country. The story is about as tragic as they come. Rasouli, 61, migrated with his family to Canada from Iran shortly before he was in need of brain surgery. Complications arose and Rasouli is now in a minimally conscious state, irreversibly so. His continuing existence relies on a ventilator doing its job and feeding through a feeding tube. The attending clinicians believe that the right course of action would be to remove the ventilator and let Rasouli’s life expire. In their considered view he will eventually die from complications resulting from the various interventions required to keep his body alive.

The Supreme Court of Canada ruled recently that Rasouli’s doctors cannot remove the ventilator unilaterally and his family’s religious beliefs require that everything be done to keep his body alive. Reportedly the cost to taxpayers of the family’s demands has been a bill of about $3.5 million. Clearly this is a lot of money to pour into futile care. Money that could be utilized to reduce hospital waiting times, among other things. The Toronto Star reports that Rasouli’s family found him space in a specialized care facility where his care will cost the provincial taxpayers only a miserly $1,000 per day. Meanwhile the family is fighting hard to get taxpayers to also cover the accommodation cost of about $1,700 per month. Again, that’s a lot of public money to pour into futile care.

The United States case

As in the Rasouli tragedy this case also hit a family ‘out of the blue’ so to speak. The 13-year-old teenager Jahi McMath underwent surgery to remove her tonsils to address her sleep apnea. Something went badly and quite unexpectedly wrong. McMath was formally declared brain dead by a judge in mid-December. The United States being what it is, a court battle ensued. The family of the deceased teenager believes fervently in religious miracles and insists that their dead daughter is moved to a care facility willing to accept the body. Just to explain, neurological, or brain death, is a technical term for the irreversible shut down of the brain. It doesn’t mean that the body can’t be kept going for a few weeks, even months, before it eventually begins to decompose. Accordingly the family hoping for their miracle will be able to notice bodily twitches, sadly not dissimilar to decapitated hens jumping around on the ground until their body finally shuts down.

A care facility operated by a former owner of a beauty salon has declared its willingness to care for the deceased – oops, the patient’s – body. Only in the United States you say? That’s quite possibly so. There are further complications in this case, requiring that the hospital where the body is currently kept ticking undertakes surgery to prepare it for transport. Luckily for the parents, the United States is a deeply religious and not terribly science literate country, so donations are flowing in generously to finance the preposterous move to the ‘care facility’ operated by the former beauty salon owner. If this wasn’t all so tragic, you can’t help but wonder when this will be turned into a reality TV show.

Unlike in Canada, none of this is about tax monies. In this case private resources are being burned to essentially play around with a dead body. There are ethical issues about demanding that doctors undertake surgery on a dead person. There are also ethical issues about what we should reasonably be permitted to do with the bodies of our deceased loved one’s.

Leaving those issues aside, however, it seems to me that an unfortunate confluence of science illiteracy and religious belief motivates families unprepared for the unexpected demise of their loved ones to go to ever greater length to keep whatever is left of their loved ones around.

High-tech permits our hospitals to oblige them with remarkable results. The highest courts in the lands are breaking new ground with regard to what can and cannot as well as what must and must not be done with these corpses. I wonder sometimes – to the dismay of most of my colleagues – whether we got the ethics of these cases all wrong.

The real patients here arguably are not the deceased (or nearly deceased) ones but their family members. Perhaps we should consider accommodating some of their seemingly outlandish wishes to give them time to let go of their loved ones. After all, it is not as if the deceased teenager will suffer as a result of being put into the so-called ‘care facility’ run by the former beauty salon manager. There are difficult issues to be resolved involving the participation of doctors in activities that do not actually serve who they consider to be the patient. What should be clear, however, is that none of this could possibly justify expending huge amounts of tax payers health care resources on futile care activities, as is currently clearly happening in Rasouli’s case.

Oh yes, and perhaps civic lessons in science literacy might be a great idea.

Wednesday, January 01, 2014

Calgary: In March this year seven-year-old Ryan Lovett died as result of cardiac arrest. His mother, after years of homeschooling her son, decided to ‘treat’ his strep infection not with antibiotics but with homeopathic concoctions and other herbal remedies.

The poor kid was bedridden for about 10 days and eventually died an entirely preventable death at the hands of his fanatic mother who had decided that her beliefs in homeopathy and ‘alternatives’ to modern medical treatments were more valid than scientific evidence. She has since been charged with criminal negligence and one can only hope that she will face the full force of the law for her omission to take her son to an actual doctor for appropriate medical care.

Tragic cases such as this are more commonplace than the more sane parents in our midst might think. Every other week such cases are reported from some place or another just in our hemisphere. No doubt there are many others who don’t even make it into the news.

It’s understandable that some people would grow weary about the integrity of pharmaceutical industry-sponsored clinical research and the medications that get subsequently approved on its evidence. Quite a few high-profile cases have made the news headlines over the years. Anyone remember Vioxx? Food and Drug Administration specialists in the USA estimated that this drug led to about anywhere between 80,000 and 140,000 heart attacks, of which a large percentage resulted in the death of the patient. There has been a lot of forth and back about the data and some suggestion has recently been made that particular patient groups could actually still benefit from this drug. Still, the baseline is that a lot of people died because the drug continued to be marketed when it was known that there were significant health risks attached to taking it.

What’s the difference between cases like the Vioxx scandal and homeopathic concoctions, herbal remedies, and whatnot? Simply put: putting your lives in the hands of purveyors of alternative, complementary etc. etc. ‘medicine’ is a bit like saying that given that modern medicine has its flaws, I’m switching to witchcraft. There is zero evidence that homeopathy works, or most of the herbal remedies that are also on the market. In fact, just this week a major study was released in the Annals of Internal Medicine, demonstrating that the vitamin concoctions that are sold to us in pharmacies and health food stores are completely useless. They are one of the reasons for why urine in our part of the world has been described as the most expensive fluid there is. We really simply release those vitamins and homeopathic concoctions right back into nature. Zero positive health effect for us.

In mainstream medicine at least we have a shot at rectifying mistakes. We have methods that eventually permit us to determine whether a particular drug works, and what its short-, medium- and long-term effects are. In hocus-pocus ‘medicine’ there isn’t even evidence – flawed or otherwise – when a concoction is given by a ‘practitioner’ to a patient. I am not suggesting that all those herbal remedies are necessarily useless. The reality is though, until they have been tested in methodologically sound clinical research nobody knows. Once they have been tested in a clinical trial and have been shown to work they cease to be alternative remedies. We call them medicine and you can get the prescribed by your doctor and some of them by some nurses.

Meanwhile in Ontario the association of naturopaths is lobbying the provincial government to regulate them as if they were a body made of professionals. They even lobby for the right to prescribe medication. For an organisation that’s representing a body of ‘practitioners’ who are overwhelmingly deeply skeptical of mainstream science and who consider the gold standard of clinical research, namely randomised controlled clinical trials, not very useful, that’s a bit rich. If you go to any of their ‘homemade’ colleges (they call themselves accredited but their accreditation is really by a body made up of colleges like themselves) you will come across a hell of a lot of unscientific nonsense. The principal idea here is a naive trust in nature’s ability to heal our disease-afflicted bodies. We are supposed to trust in our body's ability to heal itself.

Funny enough, they charge for advice based on that insight. Turns out, many more men than women follow this advice regardless of the existence of naturopaths and wait for their bodies to heal themselves. Their health outcomes are significantly poorer as a result of this. Men are much less likely than women to see doctors when they should seek medical care, hoping that their body will heal itself. That’s one of the reasons for why men die in the average about five years earlier than women.

In a rational world the naturopaths lobbying our provincial government would go nowhere. However, it looks as if they will become a self-governing health care profession some time in 2014, courtesy of our Regulated Health Professions Act. They will even have their own regulatory college, much like doctors have. This is completely bizarre. Doctors in Ontario are obliged to provide patients (as part of the informed consent process) with high levels of information about the evidence supporting the course of action they are proposing. The nature of naturopathic ‘medicine’ is such that there is no evidence worth the name that ‘practitioners’ can rely on during their consultation. Meanwhile they promise to manage conditions such as diabetes, cardiovascular diseases and so on and so forth.

What’s next, Ontario? A self-regulating College of Astrology? Welcome to Ontario 2014. Happy New Year!

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University, he tweets @schuklenk